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Need some reassurance and help- confidence shaken

We are having some problems with breast feeding this week and it is really throwing my confidence off. Here is a short run down of the last 2 weeks and 5 days (Ethan is 2 weeks and 5 days old).

He was born via cesearean after my water breaking and having meconium in it. I was dilated to a 1 and he had not dropped. I labored on Pitocin for about 9 hours and then got an epidural at 6 cm dilated this was on a Sunday at 2am. The same Sunday he was born at 5:09pm. I was not able to bfeed him after the cesarean due to my uncontrollable shaking and I don't even remember holding him until the next day. He did not get to breast until 10 hours after birth and was supplemented with human donor milk. My milk came in on day 7 or 8 and he lost 13% of his birth weight (7lbs 11 oz). He also had tongue tie and we had to get a ENT to clip it on the 5th day after he was born.

We have since gained his birth weight back (on Tuesday he weighed 8lbs 4 oz) both with breast feeding and donor milk supplementation but the supplementing ended about a week and a half ago. We had been doing well on the breast or so I thought except for these last few days.

He will be on the breast and will start crying and pulling away and furrow his brows. We switch positions, I burp him and try to calm him and it just goes on and on. He works himself into a frenzy. This is happening about 2-3 bf times a day and after these episodes he still shows signs of hunger, rooting and sucking on his fists and will not go to sleep. Sometimes he'll go about 3 hours without sleeping just crying or sleeping lightly and then waking up and crying.

I had a doula come over and tell me he is still hungry and she gave him some of my milk in a bottle and I just sobbed in the bathroom while she was feeding him. Not only because I worked so hard to get that milk (90ml) and freeze it but because I feel like I can't even satisfy him.

I have been working with 2 different lactation consultants and one says he is going through a growth spurt and the other says that my letdown is fast on the left and slow on the right (right side only producing little amounts of milk 20ml after 30 minutes BF).

I have been so committed to BF to the point where I am making myself sick with worry if this does not go right but I am really starting to get discouraged.

Is anyone else having this problem? What did or do you do? I can't stand to watch him lose weight (I am going for another weigh in tomorrow because he is losing the double chin I worked so hard to give him).

I don't want to say I am ready to throw in the towel but I can't keep crying over this it has to be causing both of us significant amounts of stress.

please help me

Other facts last 48 hours:
Diapers: May 3rd (by 2:30pm)- 6 wet and 2 poop; May 2- 8 wet and 2 poop;
BF: May 3rd (by 2:30pm)- 5 feedings and total 120 ml supp due to crying and continued rooting behavior and went 3 hours without sleeping only slept after 90ml supp; May 2- 8 feedings 3 fussy and went 3.5 hours without sleeping

Re: Need some reassurance and help- confidence shaken

Hey mama, don't panic! You're in a rough spot but it could be worse, and all sounds fixable.

Difficulty with latching is very, very common with newborn babies. Latching is an instinctive thing, but it is also a learned skill that takes time to perfect. I suggest trying the following, if you're not already:
- Try latching the baby on before he is exhibiting hunger signs. A baby who is hungry enough to be crying is often a baby who is too frantic to latch well.
- Instant reward. Before latching baby on, express a few drops of milk onto the surface of the nipple. The taste of milk may remind him that breast + sucking = milk + happiness.
- If baby is frantic, try offering him your pinky finger with nail held down towards his tongue. A few seconds of sucking on a finger may remind baby that sucking- not thrashing and screaming- will make him feel better. Once he's a little calmer, try latching him on again.
- If fast letdowns are a problem, try nursing in reclined positions, enlisting gravity to slow milk flow. Reclined positions are also great for keeping baby on the breast, because gravity holds him on the breast.
- Experiment with supplementing at the breast using either a Lact-Aid or Medela Supplemental Nursing System. At-the-breast supplementers can be tricky to use but they eliminate the need for bottles, and if your baby's difficulty with nursing is in part caused by confusion stemming from bottle use, the supplementers could help him overcome it.
- Make bottle-feeding more like nursing. When it's time to use a bottle, unbutton your shirt and cradle baby close to the bare breast. Tickle his lips with the bottle nipple until he opens WIDE- you don't want him learning sloppy latch habits from having a bottle slipped into a half-open mouth. Pause the feeding after every oz or so to get him used to the normal pauses that come with nursing.
- Try the "finish at the breast" technique. Instead of concluding feedings with a bottle, have baby end all his feedings at the breast. This teaches him to associate the feeling of satiation and calm with nursing, rather than with a bottle.

In your shoes, I think I would want more data on my side. Right now you're not sure how well baby is able to transfer milk, and that makes you understandably anxious about breastfeeding in general! I would call the LCs and see if one of them can hook you up with a professional scale. By weighing the baby before and after feedings, and subtracting the before from the after, you can gain an accurate picture of milk intake. You'll know when your baby has done a decent job at the breast, and when he hasn't. When he has, no worries and no supplements needed! When he hasn't, okay, time to feed him some expressed milk or formula.

How often are you pumping at this point? And what sort of pump are you using?

Re: Need some reassurance and help- confidence shaken

I just called our local birth center and will be picking up a medela scale tonight.

Also, I am hand expressing prior to latch. We tried the supplementer and it was so difficult we moved to bottles and my husband will give a bottle when we have to. We do the paced feeding where baby sits up and has to "work for it". I really like the idea of finishing on the breast, that is a good idea. We were bottle free for more than a week until yesterday with the doula. I could ring her neck for shaking my confidence. However, if he is not getting enough then I guess she was right.

This is so hard.

If I need to supplement with formula (because I can't pump enough breast milk- how do I chose a good one?) I don't want to keep it up forever but most important thing is for baby to thrive and for me to increase my supply by breastfeeding and pumping.

Last edited by @llli*pinkymschultz; May 3rd, 2013 at 02:36 PM.
Reason: Added question about formula

Re: Need some reassurance and help- confidence shaken

I just want to clarify -so for about a week until the doula's visit, you have not been supplementing and everything has been going fine? Has babies output been normal? Have you been checking weight gain? I'm a little confused why you think baby needs to be supplemented at this point. Is it only because of the behavior and the doulas comments? Because what you what you describe could have many causes it does not necessarily mean baby cannot extract enough milk.
I'm a little surprised the doula gave baby a bottle. Was this her idea or yours? It is not her role to ascertain a child needs to be supplemented. Unless she is also a board-certified lactation consultant or a medical Dr. she simply does not have the training necessary to make that recommendation.

Anyway if you want to do the weight check feeds that's fine. Just remember that a baby is not going to extract from the breast the same amount every time. It is normal for feeding sessions to be larger or smaller at different times.

According to my breast-feeding textbook A two week old breast-feeding baby typically takes in somewhere around 20 ounces a day that's an estimate it could be less or could be more depending on the baby. By around four weeks or so the daily intake would increase to maybe 30 ounces, but again I am not sure how reliable these numbers are- I am not sure what studies they are based on. And he would normally get this by nursing at least 10 to 12 times per day and it would be entirely normal for baby to nurse more often than that. So i'm wondering what would be considered an adequate feed-mommal, would 2 ounces be considered enough to hold off on any supplementing?
You might want to call one of your lactation consultants back and get some clarity on this. You don't want to be further undermined by a few not great before and after nursing weight checks.

Re: Need some reassurance and help- confidence shaken

We were bottle free for more than a week until yesterday with the doula. I could ring her neck for shaking my confidence. However, if he is not getting enough then I guess she was right.

Yeah, this is why I think you need more data. This could all be a confidence issue!

Have you weighed him since you stopped the supplements?

If I need to supplement with formula (because I can't pump enough breast milk- how do I chose a good one?) I don't want to keep it up forever but most important thing is for baby to thrive and for me to increase my supply by breastfeeding and pumping.

Ask your pediatrician. AFAIK, all formulas on the market- including the generic brands- have to meet the same quality control standards. So brand name vs. generic doesn't matter. And unless your baby has a well-diagnosed allergy to dairy, you want to use a milk-based rather than soy-based formula.

I really don't think you're looking at any sort of longterm relationship with supplements- if you even need them at all.

Re: Need some reassurance and help- confidence shaken

So i'm wondering what would be considered an adequate feed-mommal, would 2 ounces be considered enough to hold off on any supplementing?

According to my LCs, 2 oz was enough that I didn't need to give a supplement. Especially because my LO would nurse again within 1-2 hours.

LLLMeg gave some great advice- after reading her response I really have to wonder even more whether or not supplementing is really warranted. Having someone say "He seems hungry" just isn't a good indication of whether or not breastfeeding is going as it should!

Re: Need some reassurance and help- confidence shaken

Hi Ladies,

It was not my idea to supplement him, it was hers and I was so upset by our morning feedings not going well and his crying that when she said, "he's still rooting and sucking on his hands- he's still hungry" that I just said, "Go ahead and unfreeze some of my milk". Then I went in the bathroom turned on the fan and sobbed for about 10 minutes. She chose the largest frozen bag of milk to defrost and it took me forever to get that quantity She was not a lactation consultant and even admitted that- I was in such a fragile state at that point that I just gave in. Also, she was supposed to come backon Monday but I told her agency that while she meant well, I don't want her coming back.

RE: Supplementation- For the last 3 days during the day he has been crying at the breast about 2-3 feedings a day. He will latch for a little but then start furrowing his brow and crying, pulling off and then starting all over again. He will go on like this as long as I let him. I try switch nursing and changing positions but he still gets upset. After about an hour or 45 minutes of this behavior, I try to get him to sleep and he does not want to sleep and will be up for 3-4 hours (way too long). At which point, I try feeing him again and he gets upset again and it's this vicious cycle until he finally does fall asleep and by then I am just exhausted both physically and emotionally. When he is off the breast and fussing (during these periods) he is also rooting and sucking his hands- signs he is hungry and sobecause of this behavior and her comments I am thinking maybe he is not getting enough and I need to supplement.

meg- he has had good outputs, greater than 7 wet diapers a day and at least 4 poopy diapers a day, which is why I was confident we were doing well but his crying at the breast and acting like he is hungry but not wanting to take the breast is throwing me off and then when the doula came over- that really just sent me over the edge.

Also, we just visited the pediatricians office on Tuesday and he had surpassed his birth weight and was 8lbs 4 oz at 2 weeks 2 days old. I am taking him back in tomorrow because I don't want to second guess myself and his weight and worry about it because the stress will affect my supply.

Re: Need some reassurance and help- confidence shaken

Oh honey I wish I could give you a big hug! Look, I think your baby is fine- he is gaining very well! I know there was some supplementing but even so-over birth weight by two weeks? After tongue tie and everything else? That is amazing! Output is normal, so that is an excellent sign all is well!

Here is what may be happening. For one thing, a two-three week old baby is right on scedule for "waking up" and suddenly being STARVING ALL THE TIME. Before that babies tend toward sleepiness and may be a bit more laid back. But around two weeks, look out. Baby wants to eat and wants to eat now and wants to eat ALL THE TIME and this is NORMAL. It also may be that when baby is tired and cranky, he gets very "disorganised" and has a harder time latching and extracting milk. Then he gets frantic, so even MORE disorganised and the cycle continues. This is not really a problem (frustrating as it may be) as long as baby is getting enough milk overall. Expect a few not good or even really bad nursing sessions. That is ok, because your baby will be nursing again very soon.

The way you tell a baby is getting enough is 1) adequate weight gain (over time... don't weigh your baby every day) and 2) output. That is IT! Behavior does give us clues, of course. But it is not usually a good way to tell if baby gets enough. Particulary at such a young age when baby and you are figuring things out! Also baby will sleep when baby needs to sleep. Don't worry about that.

I suggest, Go lie down in bed (propped up nice and comfy on some pillows.) Or lean back on the couch like a lazy dude watching the game with a beer in his hand. Hold you baby. Nurse your baby. Learn your baby and let him learn you. Take care of your personal needs (showers) and (if at all possible) let someone else take care of YOU-feed you, change baby, bring you the remote etc.) You are a new mother AND recovering from abdominal surgery. You have permission to sit or lie down and relax. Have you tried nursing in a 'laid back' position?

Re: Need some reassurance and help- confidence shaken

RE: Supplementation- For the last 3 days during the day he has been crying at the breast about 2-3 feedings a day.

Oh, he's crying just 2-3 times a day? That's really nothing! Babies who are starvingly hungry tend to be inconsolable a lot more oftenthan that!

When he is off the breast and fussing (during these periods) he is also rooting and sucking his hands- signs he is hungry and sobecause of this behavior and her comments I am thinking maybe he is not getting enough and I need to supplement.

If baby is still rooting and hand-sucking after a feeding, the best thing to do in most cases is to simply put him back on the breast, and give him another chance to get his needs met there.

I am taking him back in tomorrow because I don't want to second guess myself and his weight and worry about it because the stress will affect my supply.